In an interview with ETHealthworld,Dr Haresh A Dodeja, Consultant Nephrologist and Clinical Coordinator, Fortis Hospital Mulund, Mumbai, talks about the kidney disease burden in India and ways to bring it under control. Edited excerpts:

Kidney transplant is the most important treatment for us in India but unfortunately we are placed right at the bottom when it comes to kidney transplantation because of the legislations, costs as well as the lack of a cadaver transplant programme in our country.

We would be having pockets of places in India where transplant would be done in sizeable numbers but by enlarge most of the places would still have access to a good transplant programme.

What are the challenges faced in conducting a kidney transplant?

The challenges mainly are in terms of the legislation. Our law doesn’t allow to commonly use altruistic donors and we are dependent on immediate family members. A law in Maharashtra is such that if the donor is from other state so many times we have to take permission from the government and that puts the patient back.

The problem also involves in terms of costing. A lot of patients cannot afford a kidney transplant that costs roughly about 4-6 lakhs. The main challenge is that since India now has more of nuclear families a lot of donors are not available to the patients.

Medically we cannot accept donors who have diabetes, hypertension and that takes away a lot of donors from our patients. These patients who are willing and can afford a transplant do not have access to a kidney transplant. They have to depend on a good cadaver transplant programme which is lacking in practically 95 percent of India.

I think hardly 5 percent of India has access to a cadaver transplant programme. We have to move how countries like Japan and Korea, where a cadaver transplant program rely against the blood group transplantation what we call as incompatible transplants. We have to start doing more number of those, however a lot of big hospitals in India are still shying away because that experience is limited. Though the western data, literature and the Japanese and Korean experience tells us that they work as good as the normal transplants.

What are the changes you expect to see in the coming years?

Dialysis even today is the backbone of a kidney programme. Most of the patients who cannot afford or have access to a transplant would depend on dialysis for their long term survival. It is freely available now in our country but it is still a challenge in terms of costing to make it available to everybody who needs it.

With the new Modi government, changing some legislation and planning to introduce more of dialysis centre especially available to poor people is possible. The longevity on dialysis is improving because our management of dialysis patient is improving. You can soon imagine a patient coming on dialysis and occupying that slot for the next 5 to 10 years and more and more such patients coming. So we need more and more centres to accommodate them and that is why I think dialysis will have to be looked at something which needs to be funded more by the government.

What are the preventive measures to bring down the kidney disease burden in the years to come?

Kidney disease is increasing in the world and also in India. The two main causes for kidney disease are diabetes and blood pressure. If India becomes the diabetic capital in the next decade then obviously India will also become the capital of kidney diseases in the world.

If we have to control kidney disease, then we have to control diabetes and blood pressure aggressively. These both are not diseases which we can be prevented in most of us by taking some medications, they are generally environmental diseases which have to be prevented by adapting a holistic approach and they don’t have a cure but they have a control.

We need to control these diseases better by educating the public so that they can adopt the right practices which will prevent them from having diabetes and blood pressure of uncontrolled magnitude which leads to kidney disease. Secondly educating the general practitioners and the physicians and telling them how aggressively these two diseases have to be controlled so that the disease does not percolate into kidney disease. With simple measures we can have vast impact on kidney disease and we can prevent a lot of patients from dialysis or kidney disease in future.